Question:
clauses

Allright, I am reading my booklet bluecross blueshield It says Weight reduction programs or treatment for obesity including any surgery for morbid obesity or for removal of excess fat or skin following weight loss or pregnancy, regardless of Medical Necessity or services at a helath spa or similar facility. It does not specifically say it doesn't pay for a gastric bypass...... So What are my chances of getting approval for ins.    — Nancy B. (posted on September 1, 2000)

September 1, 2000
Hmmmm....I don't think it looks good, Nancy. They actually did say "any surgery" so that, of course, includes gastric bypass. And normally it just says obesity and sometimes that can be worked with, but yours says morbid obesity, and the dreaded words "regardless of medical necessity." Not looking too good, I'm sorry to say.
   — [Anonymous]

September 1, 2000
This is not good. I am so sorry. Your ownly hope may be to try to go at this with comorbids. The diagnosis code used for the reason for surgery needs to be for one of the illnesses your obesity has caused or complicated. They may still throw it out with that Medically Necessary disclaimer but it is worth a try. Remember primary (1st)diagnosis code must be other than obesity and if I were submitting it I would use supporting diagnosis codes of anything other than obesity as well. Best not to mention it to give them ammo. You follow my thinking "we all know it but do not say it"? Other suggestion: If this does not work you may wish to contact Walter Lindstrom or try another insurance. Best of luck.
   — JennyLynn A.

August 2, 2001
I have BC/BS of Minnesota and yes they approved me for the surgery, seeming as it was medically neccessary. Unfortunatley, I became pregnant and have to prolong the surgery until March of 2002. The approval is good for a year. Hope my info helped.
   — Alexandra D.